According to the Centers for Disease Control and Prevention (CDC), 73 people have reported sick, with symptoms of vomiting and diarrhea, on Holland America’s Zaandam during a cruise through Alaska.

58 of all passengers (3.94% of 1,472) and 15 of all crew members (2.54% of 591) have reported ill to the ship infirmary during the cruise which started on June 18, 2018.  The HAL cruise ship stopped in Juneau yesterday and plans on additional stops in Alaska before returning to Seattle on July 2nd.

Several newspapers report that the outbreak is due to norovirus, although the CDC indicates that the HAL Zaandamcausative agent is currently “unknown.”

Holland America Line experienced 19 cases of GI sicknesses reported to the CDC since 2010. Only Princess Cruises suffered more norovirus/GI cases which were reported to the CDC during this time period. Last year, HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam.

Cruise ships on non-U.S. itineraries do not have to report GI outbreaks. We have previously mentioned gastrointestinal outbreaks during cruises which do not include a U.S. port, including an outbreak on the Veendam which sailed to a port in Greece last November.

Update: This afternoon I received the following email from a passenger:

“Your latest article about Holland America caught my attention.

I must admit that I am shocked that here on board there is nothing being done regarding standard sanitation before eating. On Princess there is always someone present to give you a plate after you wash your hands or use the sanitation lotion. Here on the Westerdam there is nothing being done.

I don’t see any passengers using any cleaning methods before eating. Therefore your article doesn’t surprise me. Carnival needs to use Princess as an example and get Holland America to improve. I hope this information helps and maybe something can change.

On another note, last week we were sailing in glacier Bay and all paper napkins and straws should be prohibited as they do on Princess but I caught Holland America using them and I quickly reported this to a ranger on board who was shocked.

From my point of view Holland America is lowering their standards and it’s a shame.”

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Photo credit: Barek – commons / wikimedia.

Its been a tough month for Royal Caribbean. More than 200 passengers became ill and five had to be hospitalized after an outbreak on the Ovation of the Seas during a two-week cruise between Sydney and Singapore, according to the Washington Post.

Local newspapers in South Florida are reporting today that the Independence of the Seas which left Port Everglades on Monday, for a Caribbean cruise, and returned to Fort Lauderdale this morning with at least 332 passengers sickened by a norovirus outbreak.

A cruise travel writer, @CruiseNiche, was on the cruise and posted photos on Twitter about the widespread gastrointestinal outbreak.

Independence of the Seas NoroNBC News reports that over 500 Royal Caribbean passengers have been sickened on these two cruises alone.

Last month, there was a gastrointestinal outbreak on the Anthem of the Seas. Royal Caribbean confirmed that “were a total of 98 reported cases of gastro-intestinal illness symptoms, which represents 1.9 percent of the 4,905 guests and crew onboard.”

The CDC’s Vessel Sanitation Plan requires cruise ships to send a separate notification when the GI illness count exceeds 2% of the total number of passengers or crew onboard. Cruise ship outbreak updates are posted on the CDC website only when 3% or more of the passengers and crew report symptoms to the ship infirmary during the cruise. Because there were less than than 2% of the passengers and crew members reported ill during the cruise, the CDC will not list the outbreak on its official cruise ship Outbreak Updates page.

There was also a norovirus outbreak on the Anthem of the Seas at the end of February and early March 2016 which was reported to the CDC.

Norovirus outbreaks are typically caused by contaminated food or water, according to the CDC and the FDA, although most cruise lines automatically blame their passengers for bringing the virus aboard the ship and/or spreading the outbreak by not washing their hands.

From my view, hand-washing can’t hurt, but it won’t help if the food is contaminated by an ill food handler or waiter. And of course, washing your hands won’t protect you if you contract norovirus via airborne transmission. Three years ago, in an article titled Norovirus Spreads by Air on Cruise Ships, I discussed that researchers have concluded that norovirus can spread by air, according to a publication in the highly respected Clinical Infectious Diseases. This is an issue which the cruise lines have never acknowledged.

As we have said in prior articles, don’t call us if you get sick on a cruise. Establishing where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out the source of the outbreak.

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Photo credit: @CruiseNiche

Independence of the Seas

HAL VeendamA passenger sailing on a Holland America Line (HAL) cruise ship near Greece contacted me today, stating that a number of guests are experiencing gastrointestinal symptoms:

"I’m currently on MS Veendam. Left Fort Lauderdale on October 20th and due to return to Fort Lauderdale on December 8th. Currently docked in Souda, Greece. Leaving at 5:00 pm less than an hour from now. Souda port terminal has WiFi.

Noro started about four days ago. We did pick up passengers in Barcelona and some of them are sick now and seem to have gotten sick shortly after boarding from what I understand. One day there were 29 passengers and two crew sick . . .  Yesterday …  only four new cases and no crew sick anymore. 

Ship is cleaning, isolating and taking precautions including not allowing passengers to handle food which is good."

It is currently unknown whether the gastrointestinal outbreak is in fact due to norovirus (or-coli or some other more exotic virus) because there will be no testing of the affected passenger’s stools. 

In the last week, we have written about GI outbreaks which included the Crown Princess, which called on a U.S. port and had to report the outbreak to the U.S. Centers for Disease Control and Prevention (CDC). The Anthem of the Seas was experienced a similar outbreak affected many dozens of guests (around 100 people). The Anthem did not meet the percentage of guests who reported their symptoms to the ship infirmary, and therefore there is no official CDC report.  The Celebrity Solstice was also reportedly hit with an aggressive GI outbreak while sailing around Australia, according to news accounts. 

Holland America Line experienced 18 cases of GI sicknesses reported to the CDC since 2010. Only Princess Cruises suffered more norovirus/GI cases which were reported to the CDC during this time period. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam this year.

Cruise ships on non-U.S. itineraries do not have to report GI outbreaks. 

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Photo credit: Fletcher6 – CC BY 3.0, commons / wikimedia.

A local news station in Philadelphia reports on a recent gastrointestinal outbreak on the Royal Caribbean Anthem of the Seas.

ABC-6 reports that a family from Philadelphia returned from a 7-night cruise aboar the Anthem which departed Cape Liberty, New Jersey on Saturday, November 4th. The news stations reports that on the second day of the seven day cruise, "rumors of the virus started circulating . . . and started to spread fast. Workers could be seen spraying the narrow hallways, but it was apparently spreading like wildfire." 

A newlywed woman and her husband and several of her family members became ill with symptoms of a gastrointestinal virus. 

The family complained to the news stations that "some hand sanitizing stations … didn’t have any Royal Caribbean Norovirussanitizer available to us, there were out of soap at certain sinks, there were no sanitizing stations at the elevators . . the ship’s managers (didn’t take) enough measures to stop the spread of the virus, which is not airborne but rather comes from personal touch with others or germs left on surfaces."

Royal Caribbeaan confirmed that "were a total of 98 reported cases of gastro-intestinal illness symptoms, which represents 1.9 percent of the 4,905 guests and crew onboard." 

The CDC’s Vessel Sanitation Plan requires cruise ships to send a separate notification when the GI illness count exceeds 2% of the total number of passengers or crew onboard. Cruise ship outbreak updates are posted on the CDC website only when 3% or more of the passengers and crew report symptoms to the ship informary during the cruise.

Because there were less than than 2% of the passengers and crew members reported ill during the cruise, the CDC will not list the outbreak on its official cruise ship Outbreak Updates page.

A couple of take-aways from this article. First, how many passengers did not dislose their symptoms to the ship doctor?

Secondly, there is no indication that the outbreak is related to norovirus, which cannot be confirmed until there is scientific analysis of the infected passengers’ stool samples, which will not be done because the CDC is not involved.

Thirdly, the local news station is wrong that GI virus outbreaks can’t occur through airborne transmission. Two years ago, in an article titled Norovirus Spreads by Air on Cruise Ships, I discussed that researchers have concluded that norovirus can spread by air, according to a publication in the highly respected Clinical Infectious Diseases.

Finally, don’t call us if you get sick on a cruise. Establising where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out the source of the outbreak

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Read: Gastrointestinal Outbreak on the Crown Princess, Again.

http://6abc.com/video/embed/?pid=2643100

The Centers for Disease Control (CDC) reports that there was a gastrointestinal outbreak on the Crown Princess during its recent cruise, from October 25th to November 8, 2017. The Princess cruise ship departed Quebec, Canada on October 25th for a two-week cruise to Canadian and U.S. ports. The cruise ship arrived in Fort Lauderdale, Florida on November 8th and will begin its Caribbean season.

According to the CDC report, 184 passengers and 12 crew members became ill with gastro-like symptoms which included diarrhea.  

During the period from 2010 to the current date, Princess Cruises experienced the most outbreaks on iCrown Princess Princess Cruises Norovirusts cruise ships calling on U.S. ports, according to the CDC. Princess reported twenty-one (21) cases to the CDC during this time period.

The Crown Princess alone has suffered through six (6) norovirus outbreaks since 2010 to the present. Before the current GI outbreak, the last norovirus outbreak on the Crown Princess was from January 3 – 18, 2016 and, before that, from October 18 to November 16, 2014. Earlier, there was a norovirus and e-coli outbreak from February 5 to 12, 2014. It also experienced back-to-back norovirus outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012 (photo right).

The cruise line with the second most outbreaks is Holland America Line with 18 cases of GI sicknesses reported to the CDC since 2010. HAL suffered norovirus outbreaks on the Nieuw Amsterdam, and two outbreaks each on the Volendam and the Noordam this year.  

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example? The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Are guests of HAL the second most unhygienic cruisers? Do they wash their hands the least of any cruisers? This seems like absurd arguments to make.

Is there a correlation between the age of the cruise ships and gastrointestinal outbreaks? Are different food sources and food handling techniques a more reasonable explanation? How about different sanitation procedures? 

The CDC doesn’t have time to determine the source of the norovirus outbreak (sick food handlers versus contaminated food or water or a sick passenger) so it is of no help. The CDC has not even determined the type of virus involved in the most recent outbreak on the Crown Princess.  

But blaming the passengers when one cruise line (and one cruise ship in particular) has far more gastrointestinal outbreaks than its competitors is certainly not the answer.

Whoever is to blame, the crew members, of course, always pay the price, by having to wipe and scrub and spray everything in sight for long 16+ hour days to try to disinfect a ship longer than three football fields.

Irrespective of the blame-game, don’t call us if you get sick on a cruise. Proving where the virus came from, or that the cruise line was negligent, is virtually impossible to prove, especially since the CDC conducts no epidemiological analysis and sometimes can’t even figure out whether the outbreak is due to norovirus, e-coli or something as exotic as shigella sonnei or cyclospora cayetanensis

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Read: Why Do the Cruise Lines Always Blame the Passengers When Norovirus Breaks Out?

Oceania Crew Members Pay the Price When Norovirus Hits.

Photo credit: WPTV (2012 noro outbreak); Royal Caribbean crew members (anonymous crew member).

Coral PrincessThe Coral Princess arrived in Fort Lauderdale this weekend with 157 of 2,016 cruise passengers aboard the Princess Cruises’ ship stricken with nausea/vomiting and diarrhea which the Centers for Disease Control and Prevention (CDC) suspect are symptoms related to norovirus.

The noro-infected passengers comprise 7.79% of the total passenger population on the ship. 25 of 881 (2.84%) crew members are also infected.

The CDC was unable to conclude where the norovirus came from. I am not aware of a single instance when the CDC has pinpointed the cause of a cruise ship disease outbreak. Unfortunately, the public is often left with the "blame game" of wondering whether the cruise ship food or water was contaminated (which the CDC and FDA generally say are the most likely causes of gastrointestinal outbreaks), or the outbreak was caused by a sick galley worker, or was brought aboard by sick passengers, and then spread because of inadequate hygiene and poor cleaning procedures.

Several years ago, Time magazine published an article titled 13 Worst Norovirus Outbreaks on Cruise Ships. The overall winner of Time’s top 13 list was Princess Cruises which had five outbreaks on its brand alone: Crown Princess (January 2010) with 396 ill; Crown Princess (February 2012) – 363; Ruby Princess (March 2013) – 276; Coral Princess (February 2009) – 271; and Sun Princess (July 2012) – 216.

The last norovirus outbreak involving the Coral Princess was in April 2015.

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Photo credit: Roy Luck – CC BY 2.0, commons / wikimedia.

Hat tip to the popular Crew Center blog which first covered the outbreak. 

AdoniaThe Centers for Disease Control and Prevention (CDC) reports that there was an illness outbreak on Fathom’s Adonia this past week (October 16 – October 23, 2016).

The CDC states that 23 of 668 (3.44%) passengers reported being ill with diarrhea and vomiting during this voyage which returned to Miami from Cuba yesterday. Only 2 out of the 388 crew members were reportedly sick.   

A CDC environmental health officer boarded the ship when it returned to Miami.

The CDC has not determined the cause of what appears to be a gastrointestinal outbreak.  

Fathom increased its cleaning and disinfection procedures for the cruise ship.

Fathom’s historical first cruise on the Adonia cruise ship to Cuba was plagued by a norovirus outbreak. The captain of the ship announced a gastrointestinal outbreak with the passengers experiencing symptoms consistent with norovirus on the ship last May. Carnival later contradicted the captain and said that there was no confirmation that the passengers were sickened by norovirus.   

The Adonia also suffered a complete blackout last May and was ordered to return to the port of Miami when it regained power.  It had earlier failed U.S. Coast Guard inspections in April when it arrived in Miami from P&O Cruises when it was being readied for cruises to Cuba and the Dominican Republic.

The Adonia is currently sailing to Amber Cover in the Dominican Republic.

Photo credit: By Alessandro Ambrosetti from Rome, Italy – Fathom Adonia, CC BY 2.0.

The Sun Sentinel is reporting that the Fathom Travel’s historical first cruise on the Adonia cruise ship to Cuba may have experienced a norovirus outbreak aboard the ship sickening passengers, according to reports from the captain. 

At around 2:45 P.M. this afternoon, there were at least 14 people on the ship complaining of diarrhea, vomiting and stomach cramps mentioned by the captain according to the Sun Sentinel. With only around 600 people aboard the cruise ship, that’s over 2% of the cruise passengers which is near the threshold where the Centers for Disease Control and Prevention (CDC) become involved.

The photos and video from the cruise ship show crew members already rubbing and scrubbing the surfaces of the ship. Norovirus is primarily a foodborne virus although the virus can last for weeks on contaminated surfaces. It can also be spread by person to person contact. Hand shaking on the ship is apparently discouraged. Self-serve buffets have also reportedly been replaced with service by crew members wearing gloves. 

The cruise ship, of couse, quickly blamed the passengers with the ship doctor writing a letter saying "we suspect that the virus may have been inadvertently introduced on board by embarking travelers, even though the ship had not even performed tests to make such a determination.  One of those sick, a former public health social worker, said "I think it was something I ate." Read Fears of Norovirus mar last day of cruise to Cuba.

You can see a video related to the gastrointestinal virus on the Adonia here

Norovirus on the first cruise to Cuba?  There must be a Jimmy Fallon joke here somewhere. 

May 8 2016 Update:  Spin Masters? Carnival PR team tells the Sun Sentinel that there is no verification that the Adonia guests were sick due to norovirus.

 

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Fathom Travel Adonia Ship Doctor Norovirus

 

https://youtube.com/watch?v=YBeEE9vh8kA%3Frel%3D0

The Fred Olsen Balmoral cruise ship has docked in Norfolk amidst what the Centers for Disease Control and Prevention (CDC) is saying is a norovirus outbreak which has inflicted diarrhea and vomiting symptoms on 153 of 917 (16.68%) passengers and 6 of 518 (1.16%) of crew members, over the course of the two week cruise according to a CDC report

It is the ninth gastrointestinal outbreak this year involving a cruise ship calling on a U.S. port according to the CDC

The Balmoral is an old (1987) cruise ship flagged in Nassau which has struggled with gastrointestinal illness outbreaks over the years. 300 passengers were stricken with symptoms when the ship experienced aFred Olsen Balmoral massive outbreak in May of 2015. The cruise line curtailed the cruise from 8 to 7 days to return to Southampton for "barrier cleaning." In early 2010, a newspaper reported that the Balmoral could have been detained after 250 passengers fell ill with norovirus. In an article entitled "Cursed Cruise Ship Balmoral to be Investigated," the newspaper reported that the sick cruise ship was heading from the Canary Islands to Dover, England. From 2009 to 2010, the number of those affected in three sickness outbreaks on the ship was "541 in under 12 months."

Norovirus is a disease which, although common on shore as well, is a public relations nightmare for the cruise lines. Unfortunately, gastrointestinal outbreaks on the high seas are handled differently than ashore. The cruise lines cast blame on the customers 100% of the time.  

Norovirus, according to the FDA and CDC, is primarily a food-borne disease caused by contaminated food or water.  It can also be caused by ill food handlers as well as by cruise passengers who come aboard the ship already ill.  Chipotle, for example, has taken great responsibility for norovirus outbreaks whenever they occur in one of their stores, by not opening the stores whenever a food handler becomes ill, improving food-handling policies and procedures and carefully scrutinizing food sources to determine whether the outbreak can be tracked down before it infects customers in the stores.

On cruise ships, on the other hand, neither the cruise lines nor the minimally funded and staffed CDC conduct any epidemiology analysis. The cruise lines resort simply to massive spraying, rubbing and scrubbing every surface in sight. But such measures don’t help if the lettuce comes on the ship contaminated or if handled by a sick chef who infects 75 passengers who eat a salad. Crew members are placed under incredible stress and work long hours whenever there is a code red issued. Crew lines automatically blame the personal hygiene of the passengers time after time, ship after ship, no matter the real source of the outbreak and even though no scientific process has taken place to pinpoint the true cause of the outbreak.  

I anticipate readers who will respond to this article by posting anecdotal stories of seeing passengers not bothering to wash their hands after they use public bathrooms or not using hand sanitizers, which are largely ineffective against norovirus in the first place.  

Chipotle has funded studies to investigate how it can ensure its food quality by improving food handling techniques. It clearly has a commitment to get to the root of the cause of the illness. I know of no commitment by the cruise lines to allocate any of their massive profits to study the problem. Indeed, no cruise line has even acknowledged the studies which indicate that the virus can become airborne when vomited, which seems like a massive problem given the confined space on a cruise ship. (Read: Airborne Norovirus – What Now Cruise Lines?

So there will be more and more outbreaks, the crew members will continue to be pressed to work longer hours spraying and wiping, the cruise lines will continue to blame the dirty hands of their customers, and no one will figure out the real cause of the outbreak.   

Statement by Fred Olsen: The cruise line is already blaming its guests.  It cites its alleged compliance with, among other things, the "strict" requirements of the "flag state" (Nassau).

May 8. 2016 Update:  The Centers for Disease Control and Prevention says 27 percent of the passengers aboard the Balmoral have gotten sick since the cruise began April 16th. WMTW-TV says that according to the CDC,  252 of the 919 passengers on the Balmoral have fallen ill, as well as eight crew members.   

May 11 2016 Update:  The CDC says the total number of passengers sickened since the beginning of the cruise has increased to 272 passengers. According to the Evening Standard, Cruise ship Balmoral was infected with vomit bug BEFORE setting sail.  

 

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Photo credit: LesMeloures CC BY-SA 3.0, commons / wikimedia (photo taken 2008 before paint change)

    

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P&O OceanaA month ago, a crew member aboard the P&O Oceana notified me that the cruise ship failed a sanitation inspection by the enters for Disease Control and Prevention (CDC) while the ship was in port in Charleston, South Carolina.  Oceana received a score of 82; 85 or lower is considered a failure.

I have been checking the CDC’s online inspection scores since then. I have been asking the CDC when it will release its report on the Oceana.

The report was finally released today. You can read the report here. The report indicated that several back-flow prevention devices, to prevent the contamination of potable water, did not have test results and appeared not to be tested. The ship’s Riviera swimming pool and Crystal whirlpool did not have adequate levels of chlorinated and bromine, failed to have hair and lint strainers / filters and were not disinfected. The inspector closed the recreational water facilities on the ship.

The report also revealed that a food handler had an onset of Acute Gastroenteritis (AGE) and exhibited symptoms at 9:00 A.M. in the morning but did did not report to the medical center until 11:20 A.M. A review of the crew member’s work history indicated that this crew member worked, notwithstanding his illness, from 7:30 A.M. until 10:30 A.M.

The ship’s galley appeared dirty. There were comments like “the tile grout in this area was soiled and in disrepair.”  “The deck below under counter refrigerator . . . had a significant buildup of more than a week’s accumulation of food debris, dirt, equipment parts, and what appeared to be insect remains.” Food service equipment was broken or out of service and many operational ovens and ice-makers were overflowing their drip pans and/or leaking onto the floor.

Oceana has not prepared a “corrective action report” in response to the failed score, as required by the CDC.

In an era when cruise lines are quick to blame every single norovirus outbreak on the passengers, this CDC report provides an insight into how deficient water sanitation and disgusting food handling practices by a cruise line can jeopardize the health of the traveling public.

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April 4, 2016 Update: The CDC vessel sanitation inspectors inspected the P&O Oriana in February.  Although the cruise ship passed with a score of 90, there were several significant sanitation problems including dirty and out of service galley equipment.  Also food handlers working while ill with gastrointeritis: “A Chef de Partie experienced onset of GI symptoms on 20 January 2016 at 6:45 am. This crew member worked from 7 am to 11 am, took lunch at the crew mess, then returned to work from 1 pm to 5 pm. The chef reported his symptoms to the medical center at 6 pm.”   You can read the report here.

April 5, 2016 Update:  Cruise Law News was quoted today in the Southampton’s Daily  Echo and the U.K.’s Daily Mail.

Fortune magazine also covered the story, writing that it “raises questions about the industry’s squeaky-clean image, and indeed, that there may be more unreported cases that were either ignored or dismissed by the sickened passengers or the cruise lines themselves.”

April 6, 2016 Update:  FoxNews covers the story today – Health inspectors find cockroaches, ‘potentially hazardous’ food aboard two luxury cruise ships.  The Cruise Line International Association (CLIA) interjects the blame-the-passenger-wash-your-hands excuse but ignores the fact that crew members were handling food while contagious and the ship’s galley was found to be unsanitary and potentially hazardous to the guests’ health.

Photo credit: Piergiuliano Chesi, CC BY 3.0, commons / wikimedia.